Healthcare Provider Details

I. General information

NPI: 1942858840
Provider Name (Legal Business Name): MARCI MONTAGUE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4304 CANONGATE CT
SPRING HILL FL
34609-0498
US

IV. Provider business mailing address

4304 CANONGATE CT
SPRING HILL FL
34609-0498
US

V. Phone/Fax

Practice location:
  • Phone: 814-795-7550
  • Fax:
Mailing address:
  • Phone: 814-795-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11003952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: